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EX~IZBIT '-Btt <br />OF SCRRA FARM N4.6 <br />RAILROAD PROTECTIVE LIABILITY POLICY <br />DECLARATION <br />POLICY <br />Insurance Company: <br />Policy Number: <br />Policy Period: <br />From: To: <br />12:01 am Standard time at location <br />CERTIFICATE HOLDER AND ADDITIONALLY INSURED <br />Southern California Regional Rail Authority (SCRRA) tficate Holder/Insured: <br />700 South Fiower Street, Suite 2600, Los Angeles, CA 90017-4101 <br />Additionally Insured: <br />Los Angeles County Metropolitan Transportation Authority (MTA <br />Orange County Transportation Authority (OCTA) ) Burlington Northern Santa Fe Corporation (BNSF) <br />Riverside County Transportation Commission (RCTC) Union Pacific Rar7road Company (UPRR) <br />San Bernardino Associated Governments (SANBAG) National Railroad Passenger Corporation (Amtak) <br />Vetrtura County Transportation Commission (VCTC) <br />LIMITS OF INSURANCE <br />Aggregate Limit 56,000,000 Each Occurrence Limit <br />52,000,000 <br />DESCRIPTION OF WORK AND JOB LOCATION(S) <br />NAME AND ADDRESS OF DESIGNATED CONTRACTOR <br />NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY <br />PREMIUM <br />Contract Cost <br />Premium Base <br />FORM OF ENDORSEMENT <br />Title <br />Rate per 1,000 of <br />umber <br />COUNTERSIGNATURE <br />Countersigned by <br />SCRRA FORM N0.6 <br />(Authorized Representative) <br />Page 12 of 13 <br />Date <br />Advance Premium <br />Rev. 9/I 8106 <br />